Grade Dorothea, Cip Johannes, Lengnick Harald
Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
J Orthop Case Rep. 2023 May;13(5):87-91. doi: 10.13107/jocr.2023.v13.i05.3658.
Patients with lateral instability of the ankle have a much higher prevalence of an os subfibulare compared with the general population. In children and adolescents with known os subfibulare and chronic instability of the ankle, surgical resection of the os subfibulare and the Broström/Gould procedure to reattach the ATFL to the fibula has been described if conservative therapy fails.
Our case is about a 10-year-old girl with chronic instability of the ankle and a symptomatic os subfibulare, with additional cystic and edematous changes in the distal fibula in the MRI. Due to the reduced bone density, we assumed a higher risk of anchor pullout with the normal refixation at the distal fibula. Therefore, the surgical technique according to Broström/Gould was modified and the ATFL was refixed on the talar side.
In cases of symptomatic os subfibulare with clinical instability of the ankle, a Broström/Gould operation and resection of the os subfibulare is recommended after failure of conservative therapy. Our case showed that a very satisfying post-operative result can be achieved with a modification of the Broström/Gould operation, with reattachment of the ATFL to the talus instead of the fibula.
与普通人群相比，踝关节外侧不稳定患者的腓下骨出现率要高得多。对于已知存在腓下骨且踝关节慢性不稳定的儿童和青少年，如果保守治疗失败，已有文献报道可采用腓下骨手术切除及Broström/Gould手术将距腓前韧带重新附着于腓骨。
我们的病例是一名10岁女孩，踝关节慢性不稳定且腓下骨有症状，磁共振成像显示腓骨远端有额外的囊性和水肿性改变。由于骨密度降低，我们认为在腓骨远端进行常规重新固定时，锚钉拔出的风险更高。因此，对Broström/Gould手术技术进行了改良，将距腓前韧带重新固定在距骨侧。
对于有症状的腓下骨且踝关节临床不稳定的病例，保守治疗失败后建议进行Broström/Gould手术及腓下骨切除。我们的病例表明，对Broström/Gould手术进行改良，将距腓前韧带重新附着于距骨而非腓骨，可取得非常满意的术后效果。
